Before discussing the implications of these observations, it is necessary to consider their reliability. The data in Table 1 are shown because of the possibility that the cases having the background information about alcohol use might not be representative of those for whom this information was not recorded. While the table shows a trend for values to be larger in the group with known history, only one pair of values (prevalence of emphysema) approached statistical significance (p = 0.Q5) using the x2 test.
Alcohol is one of the drugs of abuse and, when taken in excess, is clearly capable of producing irreversible damage to several organs, including the liver, brain, and myocardium. Yet it has certain felicitous effects, as a result of which it is used by the majority of the population of this country. Since excessive use has such significant effects, it has long been suspected that moderate consumption also may cause less obvious injury to these or other organs. One organ system which has been considered at risk is the respiratory tract. The susceptibility to tuberculosis and other pulmonary infections is increased, and lung abscesses due to aspiration also are more common.
In patients with PAH, increasing PAP eventually leads to right-sided heart failure and often to sudden cardiac death. Available treatments consist of anticoagulation and pulmonary vasodilators such as phosphodiesterase-5 inhibitors, endothelin-receptor antagonists, calcium-channel blockers, or prostanoids, but patients with severe right-heart failure and low cardiac output are often refractory to these agents.
In recent years, atrial septostomy has emerged as palliative therapy or bridge to transplantation. In severe PAH, this procedure creates a right-to-left shunt reducing right ventricle preload. It has been shown to result in an increased cardiac output and an augmentation of systemic oxygen transport despite the fall in systemic arterial oxygen satura-tion. A major drawback of the procedure is the high incidence of spontaneous closure or decrease in orifice size, with repeat septostomy being required in 3 to 17% depending on the performed technique. Oversizing of the orifice represents another hazard, leading to severe hypoxia or left ventricular failure due to an excessive shunt volume.
High-altitude pulmonary edema (HAPE) is a form of noncardiogenic pulmonary edema, which affects between 0.2% and 15% of people who ascend to altitudes between 2,500 and 5,000 m, and which may be fatal if not recognized and treated promptly. Given the increasing number of people traveling to alpine regions for work or pleasure, improving our ability to prevent, diagnose, and manage HAPE would be of great benefit, as would an increased understanding of its pathophysiology. With regard to new prophylactic drugs, Maggiorini et al recently demonstrated a benefit for the phosphodiesterase inhibitor tadalafil and the corticosteroid dexamethasone in preventing HAPE in known susceptible individuals. On the diagnostic front, Fagen-holz and colleagues in this issue of CHEST describe a relatively simple diagnostic technique that has the potential to enhance our understanding of the time course of the disease and to facilitate research on other important questions related to its development.
An analysis of respiratory symptoms is shown in Tables 2 and 3. The results confirm the findings in the previous report of 298 women. Daily chronic cough was unusual in nonsmokers and ex-smokers, but the prevalence became progressively greater with increase in the number of cigarettes smoked (Table 2(a)). The prevalence of cough was significantly greater in all smoking groups compared with nonsmokers and ex-smokers (P<0.001). Sputum production followed the same pattern as cough and the prevalence of sputum production was greater in all smoking groups than among nonsmokers and exsmokers (P<0.001) (Table 2(b)). Sputum volume was usually small but there were 17 women who produced more than a tablespoonful in 24 hours and, of these, 16 were moderate or heavy smokers and one was a nonsmoker (Table 2(c)). The sputum was usually clear, white or gray but there was an increased prevalence of yellow or green sputum (at least in part or with colds) in moderate and heavy smokers. Seven women had usually yellow or green sputum (one moderate and six heavy smokers). There was a progressive increase in the prevalence of chronic bronchitis (chronic cough and sputum present on most days during at least three months in each of two successive years),2 with increase in cigarette smoking, and the differences between smoking groups and nonsmoking groups were highly significant (P<0.001) (Table 2(d)). Almost half of the heavy smokers might be considered to have chronic bronchitis. Many of the smokers had had an increase in sputum in the previous five years and even during the previous year, and there were significant differences between nonsmokers and smokers in this respect (P<0.05), (Table 2(e)).
A comparison of smoking habits in the United States in 1955 and in 1966 showed a drop in cigarette consumption in men under 55 years of age, but among women, there was an increase in cigarette consumption for every age group. Another survey in the spring of 1970 showed a much larger drop in cigarette consumption in the four years from 1966 to 1970 compared with the 11 years from 1955 to 1966. This drop was particularly noted in men under 64 years of age and, for the first time, the increase in cigarette consumption among women under 55 years of age leveled off. The increase among women over 55 years was of a lesser magnitude than previously. Similar results have been found in surveys by the Department of National Health and Welfare in Canada but of particular concern is the increase of regular smokers reported among girls 15 to 19 years of age, from 19 percent in 1965 to 25 percent in 1970. Recently, there has been increasing attention paid to women smokers because of the relationship between maternal smoking during pregnancy and harm to the unborn child. Protect yoursef in case of erectile dysfunction together with My Canadian Pharmacy – https://mycanadian-pharmacy.net/secure-the-unborn-child-during-the-treatment-of-erectile-dysfunction-my-canadian-pharmacy-has-got-some-suggestions.html.
The present investigation of 500 women is an extension of a study of 298 women reported in 1971. The study as a whole had been designed to investigate 500 women as it was considered likely that this number would be required for definitive conclusions to be made. The impression was reinforced by preliminary analysis of data from the first 100 women examined where no statistical differences were shown between the smokers and nonsmokers in clinical findings, sputum examinations and pulmonary function tests. After 200 women had been examined, differences became apparent and, in the published report of 298 women, many differences between the smokers and nonsmokers were found. It was shown that, with increase in cigarette smoking, the prevalence of cough, sputum production, wheezing and shortness of breath increased progressively. Abnormalities on physical examination of the chest were found more frequently in smokers than in nonsmokers. Cytologic abnormalities were found in the sputum but differences between smokers and nonsmokers were not statistically significant. The results of tests of ventilatory function and of gas transfer (during exercise ) were lower in smokers than in nonsmokers.